016.06.05 Ark. Code R. 022 - ElderChoices Update Transmittal #50

213.400 Personal Emergency Response System

Procedure Code	Required Modifier	Description
S5161	UA	PERS Unit
S5160	-	PERS Installation

The Personal Emergency Response System (PERS) is an in-home, 24-hour electric support system with two-way verbal and electronic communication with an emergency control center. PERS enables an elderly, infirm or homebound individual to secure immediate help in the event of a physical, emotional or environmental emergency.

PERS is specifically designed for high-risk individuals whose needs have been carefully determined based on their level of medical vulnerability, functional impairment and social isolation. PERS is not intended to be a universal benefit. The DHS RN must verify that the individual is capable, both physically and mentally, of operating the PERS unit.

PERS must be prescribed by the client's attending physician and must be included in the client's written plan of care.

PERS providers must contact each client at least once per month to test the system's operation. The provider shall maintain a log of test calls that includes the date and time of the test, specific test results, corrective actions and outcomes.

A log of all client calls received must be maintained by the emergency response center. The log must reflect the date, time and nature of the call and the response initiated by the center. All calls must be documented in the client's record. See section 214.000 for other documentation requirements.

One (1) unit of service equals one (1) day. PERS is limited to a maximum of thirty-one (31) units per month.

The installation of PERS will be allowed once per lifetime or period of eligibility. Claims submitted for the installation of PERS should use procedure code S5160. Procedure code S5160 may be billed for ElderChoices clients who are accessing PERS services for their first time or for the current period of re-eligibility for ElderChoices Waiver Services. In the event of extenuating circumstances that result in the need for reinstallation, the provider may contact the Division of Aging and Adult Services for extension of the benefit.

View or print Division of Aging and Adult Services contact information.

262.100 HCPCS Procedure Codes

The following procedure codes must be billed for ElderChoices Services:

Procedure Code	Required Modifier	Description	Unit of Service	POS for Paper Claims	POS for Electronic Claims
S5140	-	Adult Foster Care	1 day	0	99
S5130	-	Homemaker Services	15 min	4	12
S5170	U2	Home-Delivered Meals	1 meal	4	12
S5161	UA	Personal Emergency Response System	1 day	4	12
S5100	-	Adult Day Care 6 to 8 hours per date of service	15 min	5	52
S5100	TD	Adult Day Health Care 6 to 8 hours per date of service	15 min	5	52
T1005	-	Respite Care - Long-term Facility-Based	15 min	1 or 7	21 or 33
S5120	-	Chore Services	15 min	4	12
S5135	-	Respite Care - Short-term Facility-Based	15 min	5,1,7	52,21,33
S5150	-	Respite Care - In-Home	15 min	4	12
S5100	TD, U1	Adult Day Health Care 4 or 5 hours per date of service	15 min	5	52
S5100	U1	Adult Day Care 4 or 5 hours per date of service	15 min	5	52
S5170	ET	Emergency Home Delivered Meals	1 meal	4	12
S5160	"	Personal Emergency Response System -Installation	1 installation	4	12
S5170	-	Frozen Home-Delivered Meal	1 meal	4	12

Notes

016.06.05 Ark. Code R. 022

6/3/2005